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Chen Z, Bains SS, Hameed D, Dubin JA, Stern JM, Mont MA. Robust Randomized Controlled Data Is Lacking in Total Joint Arthroplasty. J Knee Surg 2022; 35:1533-1539. [PMID: 36427523 DOI: 10.1055/s-0042-1758550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Randomized controlled trials (RCTs)are regarded as highest level of scientific evidence. There is belief that while prospective randomized control trials (PRCTs) are the gold standard for evaluating efficacy of interventions, there are very few conducted on lower extremity joint arthroplasty. However, there was a more than adequate amount (n=197) of published RCTs in knee arthroplasty during the 2021 calendar year. Therefore, we studied RCTs on knee arthroplasties for 2021 and assessed them for overall study topic reasons (i.e., devices as well as prostheses, rehabilitation, pain control, blood loss [tranexamic acid], and other), which were then subcategorized by: (1) country of origin; (2) sample size; and (3)whether or not they were follow-up studies. After this, we specifically focused on the studies (n=26) concerning devices or prostheses. METHODS A search of PubMed on "knee arthroplasty" specifying "RCT" using their search function and dates between January 1, 2021 to December 24, 2021 resulted in the analyzed reports. A total of 17.3% reports analyzed rehabilitation methods while 28.4% studied pain control. A total of 20.3% examined blood loss topics and 20.8% investigated other topics. RESULTS We found that 26 studies (13.2%) involved prosthetic design and implantation. Overall, only 15% knee arthroplasty RCTs were conducted in the United States, the mean total final sample size was 133±146 patients, and 7% were follow-up studies. None of the prostheses studies were performed in the United States, and the mean total final sample size of all of these studies was 86±54 patients, and 23% were follow-up studies. Total knee arthroplasty prospective RCTs were not performed in the United States. CONCLUSION The authors believe that other study designs, such as database or registry analyses, are also appropriate in this rapidly advancing field of joint arthroplasty for the continuing evaluation and approval of new prostheses and techniques, while we await more PRCTs in our field.
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Affiliation(s)
- Zhongming Chen
- Department of Orthopedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Sandeep S Bains
- Department of Orthopedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Daniel Hameed
- Department of Orthopedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Jeremy A Dubin
- Department of Orthopedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Jonathan M Stern
- Department of Orthopedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Michael A Mont
- Department of Orthopedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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A Proposal for a Classification Guiding the Selection of Appropriate Antibiotic Therapy for Intra-Abdominal Infections. Antibiotics (Basel) 2022; 11:antibiotics11101394. [PMID: 36290052 PMCID: PMC9598485 DOI: 10.3390/antibiotics11101394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
Adequately controlling the source of infection and prescribing appropriately antibiotic therapy are the cornerstones of the management of patients with intra-abdominal infections (IAIs). Correctly classifying patients with IAIs is crucial to assessing the severity of their clinical condition and deciding the strategy of the treatment, including a correct empiric antibiotic therapy. Best practices in prescribing antibiotics may impact patient outcomes and the cost of treatment, as well as the risk of “opportunistic” infections such as Clostridioides difficile infection and the development and spread of antimicrobial resistance. This review aims to identify a correct classification of IAIs, guiding clinicians in the selection of the best antibiotic therapy in patients with IAIs.
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Yoon YK, Kim J, Moon C, Lee MS, Hur J, Lee H, Kim SW. Antimicrobial Susceptibility of Microorganisms Isolated from Patients with Intraabdominal Infection in Korea: a Multicenter Study. J Korean Med Sci 2019; 34:e309. [PMID: 31808326 PMCID: PMC6900408 DOI: 10.3346/jkms.2019.34.e309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/07/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study evaluated the antimicrobial susceptibility of pathogens isolated from Korean patients with intraabdominal infections (IAIs). METHODS This multicenter study was conducted at 6 university-affiliated hospitals in Korea between 2016 and 2018. All patients with microbiologically proven IAIs were retrospectively included, while patients with spontaneous bacterial peritonitis or continuous ambulatory peritoneal dialysis peritonitis were excluded. Identification and antimicrobial susceptibility testing were performed using automated microbiology systems. RESULTS A total of 2,114 non-duplicated clinical isolates were collected from 1,571 patients. Among these pathogens, 510 (24.1%) were isolated from nosocomial infections, and 848 isolates (40.1%) were associated with complicated IAIs. The distribution of the microorganisms included aerobic gram-negative (62.6% of isolates), aerobic gram-positive (33.7%), anaerobic (0.9%), and fungal (2.8%) pathogens. The most common pathogens were Escherichia coli (23.8%), followed by Enterococcus spp. (23.1%) and Klebsiella spp. (19.8%). The susceptibility rates of E. coli and Klebsiella spp. to major antibiotics were as follows: amoxicillin/clavulanate (62.5%, 83.0%), cefotaxime (61.4%, 80.7%), ceftazidime (63.7%, 83.1%), cefepime (65.3%, 84.3%), ciprofloxacin (56.4%, 86.3%), piperacillin/tazobactam (99.0%, 84.8%), amikacin (97.4%, 98.3%), and imipenem (99.8%, 98.8%). The susceptibility rates of Enterococcus spp. to ampicillin were 61.0%, amoxicillin/clavulanate, 63.6%; ciprofloxacin, 49.7%; imipenem, 65.2%; and vancomycin, 78.2%. The susceptibility rates of Pseudomonas aeruginosa and Acinetobacter spp. to imipenem were 77.4% and 36.7%, respectively. CONCLUSION Enterococcus spp. with susceptibility to limited antibiotics was one of the main pathogens in Korean IAIs, along with E. coli and Klebsiella spp., which were highly susceptible to imipenem, amikacin, and piperacillin/tazobactam. Meanwhile, the low susceptibilities of E. coli or Klebsiella spp. to amoxicillin/clavulanate, advanced-generation cephalosporins, and ciprofloxacin should be considered when determining empirical antibiotic therapy in clinical practice.
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Affiliation(s)
- Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jieun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Chisook Moon
- Division of Infectious Diseases, Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Mi Suk Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jian Hur
- Division of Infectious Diseases, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Hojin Lee
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Shin Woo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
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4
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Sartelli M, Abu-Zidan FM, Labricciosa FM, Kluger Y, Coccolini F, Ansaloni L, Leppäniemi A, Kirkpatrick AW, Tolonen M, Tranà C, Regimbeau JM, Hardcastle T, Koshy RM, Abbas A, Aday U, Adesunkanmi ARK, Ajibade A, Akhmeteli L, Akın E, Akkapulu N, Alotaibi A, Altintoprak F, Anyfantakis D, Atanasov B, Augustin G, Azevedo C, Bala M, Balalis D, Baraket O, Baral S, Barkai O, Beltran M, Bini R, Bouliaris K, Caballero AB, Calu V, Catani M, Ceresoli M, Charalampakis V, Jusoh AC, Chiarugi M, Cillara N, Cuesta RC, Cobuccio L, Cocorullo G, Colak E, Conti L, Cui Y, De Simone B, Delibegovic S, Demetrashvili Z, Demetriades D, Dimova A, Dogjani A, Enani M, Farina F, Ferrara F, Foghetti D, Fontana T, Fraga GP, Gachabayov M, Gérard G, Ghnnam W, Maurel TG, Gkiokas G, Gomes CA, Guner A, Gupta S, Hecker A, Hirano ES, Hodonou A, Hutan M, Ilaschuk I, Ioannidis O, Isik A, Ivakhov G, Jain S, Jokubauskas M, Karamarkovic A, Kaushik R, Kenig J, Khokha V, Khokha D, Kim JI, Kong V, Korkolis D, Kruger VF, Kshirsagar A, Simões RL, Lanaia A, Lasithiotakis K, Leão P, Arellano ML, Listle H, Litvin A, Lizarazu Pérez A, Lopez-Tomassetti Fernandez E, Lostoridis E, Luppi D, Machain V GM, Major P, Manatakis D, Reitz MM, Marinis A, Marrelli D, Martínez-Pérez A, Marwah S, McFarlane M, Mesic M, Mesina C, Michalopoulos N, Misiakos E, Moreira FG, Mouaqit O, Muhtaroglu A, Naidoo N, Negoi I, Nikitina Z, Nikolopoulos I, Nita GE, Occhionorelli S, Olaoye I, Ordoñez CA, Ozkan Z, Pal A, Palini GM, Papageorgiou K, Papagoras D, Pata F, Pędziwiatr M, Pereira J, Pereira Junior GA, Perrone G, Pintar T, Pisarska M, Plehutsa O, Podda M, Poillucci G, Quiodettis M, Rahim T, Rios-Cruz D, Rodrigues G, Rozov D, Sakakushev B, Sall I, Sazhin A, Semião M, Sharda T, Shelat V, Sinibaldi G, Skicko D, Skrovina M, Stamatiou D, Stella M, Strzałka M, Sydorchuk R, Teixeira Gonsaga RA, Tochie JN, Tomadze G, Ugoletti L, Ulrych J, Ümarik T, Uzunoglu MY, Vasilescu A, Vaz O, Vereczkei A, Vlad N, Walędziak M, Yahya AI, Yalkin O, Yilmaz TU, Ünal AE, Yuan KC, Zachariah SK, Žilinskas J, Zizzo M, Pattonieri V, Baiocchi GL, Catena F. Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: a WSES observational study. World J Emerg Surg 2019; 14:34. [PMID: 31341511 PMCID: PMC6631509 DOI: 10.1186/s13017-019-0253-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/03/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted. METHODS This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018. RESULTS A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO2) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8. CONCLUSIONS The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.
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Affiliation(s)
| | - Fikri M. Abu-Zidan
- 0000 0001 2193 6666grid.43519.3aDepartment of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | - Yoram Kluger
- 0000 0000 9950 8111grid.413731.3Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Federico Coccolini
- 0000 0004 1758 8744grid.414682.dDepartment of Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- 0000 0004 1758 8744grid.414682.dDepartment of Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Ari Leppäniemi
- 0000 0004 0410 2071grid.7737.4Abdominal Center, Department of Abdominal Surgery, Helsinki University Hospital Meilahti and University of Helsinki, Helsinki, Finland
| | - Andrew W. Kirkpatrick
- 0000 0004 0469 2139grid.414959.4General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB Canada
| | - Matti Tolonen
- 0000 0004 0410 2071grid.7737.4Abdominal Center, Department of Abdominal Surgery, Helsinki University Hospital Meilahti and University of Helsinki, Helsinki, Finland
| | - Cristian Tranà
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - Jean-Marc Regimbeau
- 0000 0004 0593 702Xgrid.134996.0Department of Digestive Surgery and SSPC Research Unit, CHU Amiens-Picardie, Amiens, France
| | - Timothy Hardcastle
- 0000 0001 0723 4123grid.16463.36Department of Trauma ICU, IALCH, University of KwaZulu-Natal, Durban, South Africa
| | - Renol M. Koshy
- 0000 0004 0400 5079grid.412570.5Department of General Surgery, University Hospital of Coventry & Warwickshire, Coventry, UK
| | - Ashraf Abbas
- 0000000103426662grid.10251.37Department of Surgery, Mansoura University and Emergency Hospital, Mansoura, Egypt
| | - Ulaş Aday
- Department of Gastrointestinal Surgery, University of Health Sciences, Elazig Training and Research Hospital, Elazig, Turkey
| | - A. R. K. Adesunkanmi
- 0000 0001 2183 9444grid.10824.3fDepartment of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Adesina Ajibade
- 0000 0001 0583 749Xgrid.411274.5Department of Surgery, LAUTECH Teaching Hospital, Osogbo, Nigeria
| | - Lali Akhmeteli
- 0000 0004 0428 8304grid.412274.6Department of Surgery, TSMU First University Clinic, Tbilisi, Georgia
| | - Emrah Akın
- 0000 0001 0682 3030grid.49746.38Department of General Surgery, Sakarya University Research and Educational Hospital, Sakarya, Turkey
| | - Nezih Akkapulu
- 0000 0004 0642 1084grid.411920.fDepartment of General Surgery, Hacettepe University Hospital, Ankara, Turkey
| | - Alhenouf Alotaibi
- 0000 0004 0593 1832grid.415277.2Department of Surgical Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fatih Altintoprak
- Department of General Surgery, Istinye University Faculty of Medicine, Istanbul, Turkey
| | | | - Boyko Atanasov
- 0000 0001 0726 0380grid.35371.33Surgical Department, UMHAT “Eurohospital”, Medical University, Plovdiv, Bulgaria
| | - Goran Augustin
- 0000 0004 0397 9648grid.412688.1Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Constança Azevedo
- Cirurgia Geral, Centro Hospitalar Universitário da Cova da Beira, Covilhã, Portugal
| | - Miklosh Bala
- 0000 0001 2221 2926grid.17788.31Department of General Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Dimitrios Balalis
- Department of Surgery, Saint Savvas Anticancer Hospital, Athens, Greece
| | | | - Suman Baral
- Department of Surgery, Lumbini Medical College and Teaching Hospital Ltd., Tansen, Palpa Nepal
| | - Or Barkai
- 0000 0000 9950 8111grid.413731.3Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Marcelo Beltran
- Department of Surgery, Hospital San Juan de Dios de La Serena, La Serena, Chile
| | - Roberto Bini
- Emergency and General Surgery, SG Bosco, Torino, Italy
| | | | - Ana B. Caballero
- 0000 0004 0465 2778grid.461067.2General Surgery, Hospital Santo Tomas, Panama, Panama
| | - Valentin Calu
- Department of Surgery, Elias Emergency Hospital, Bucharest, Romania
| | - Marco Catani
- grid.417007.5Dipartimento Emergenza e Accettazione, Policlinico Umberto I, Roma, Italy
| | - Marco Ceresoli
- 0000 0004 1756 8604grid.415025.7Department of General and Emergency Surgery, ASST Monza - Ospedale San Gerardo, Monza, Italy
| | - Vasileios Charalampakis
- 0000 0004 0478 4463grid.440196.eGeneral Surgery, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Asri Che Jusoh
- Department of General Surgery, Kuala Krai Hospital, Kuala Krai, Malaysia
| | - Massimo Chiarugi
- 0000 0004 1756 8209grid.144189.1U.O. Chirurgia d’Urgenza Universitaria, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Nicola Cillara
- grid.459832.1U.O.C. Chirurgia Generale, PO Santissima Trinità, Cagliari, Italia
| | - Raquel Cobos Cuesta
- 0000 0004 1771 208Xgrid.418878.aUGC Cirugía General, Complejo Hospitalario de Jaén, Jaén, Spain
| | - Luigi Cobuccio
- 0000 0004 1756 8209grid.144189.1U.O. Chirurgia d’Urgenza Universitaria, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Gianfranco Cocorullo
- Department of General and Emergency Surgery, Azienda Ospedaliera Policlinico Universitario Palermo “Paolo Giaccone”, Palermo, Italy
| | - Elif Colak
- General Surgery, University of Health Sciences, Samsun Training and Research Hospital, Samsun, Turkey
| | - Luigi Conti
- Department of Surgery, G. Da Saliceto Hospital, Piacenza, Italy
| | - Yunfeng Cui
- grid.417036.7Department of Surgery, Tianjin Nankai Hospital, Tianjin, China
| | - Belinda De Simone
- Chirurgie Viscerale et d’Urgence, Centre Hospitalier Regional de Perpignan, Perpignan, France
| | - Samir Delibegovic
- 0000 0001 0682 9061grid.412410.2Department of Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Zaza Demetrashvili
- Department of Surgery, Kipshidze Central University Hospital, Tbilisi, Georgia
| | - Demetrios Demetriades
- 0000 0001 0084 1895grid.411409.9Division of Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, USA
| | - Ana Dimova
- 0000 0004 0397 9648grid.412688.1Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Agron Dogjani
- Department of General Surgery, University Hospital of Trauma, Tirana, Albania
| | - Mushira Enani
- 0000 0004 0593 1832grid.415277.2Department of Infectious Diseases, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Federica Farina
- 0000 0004 0625 0318grid.459640.aChirurgia Generale, Ospedale Versilia, La Spezia, Italy
| | - Francesco Ferrara
- grid.414126.4Department of Surgery, San Carlo Borromeo Hospital, Milan, Italy
| | - Domitilla Foghetti
- grid.415103.2Department of General Surgery, San Salvatore, Pesaro, Italy
| | - Tommaso Fontana
- Department of General and Emergency Surgery, Azienda Ospedaliera Policlinico Universitario Palermo “Paolo Giaccone”, Palermo, Italy
| | - Gustavo P. Fraga
- 0000 0001 0723 2494grid.411087.bDivision of Trauma Surgery, Hospital de Clinicas, University of Campinas, Campinas, Brazil
| | - Mahir Gachabayov
- Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
| | - Grelpois Gérard
- 0000 0004 0593 702Xgrid.134996.0Department of Surgery, University hospital, Amiens, France
| | - Wagih Ghnnam
- grid.469958.fDepartment of General Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Teresa Giménez Maurel
- 0000 0000 9854 2756grid.411106.3Department of General Surgery, Miguel Servet, Zaragoza, Spain
| | - Georgios Gkiokas
- 0000 0001 2155 0800grid.5216.02nd Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Carlos A. Gomes
- Department of Surgery, Hospital Universitário Terezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, Brazil
| | - Ali Guner
- 0000 0001 2186 0630grid.31564.35Department of General Surgery, Karadeniz Technical University, Trabzon, Turkey
| | - Sanjay Gupta
- 0000 0004 1767 2831grid.413220.6Department of General Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Andreas Hecker
- 0000 0000 8584 9230grid.411067.5Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Elcio S. Hirano
- 0000 0001 0723 2494grid.411087.bDivision of Trauma Surgery, Hospital de Clinicas, University of Campinas, Campinas, Brazil
| | - Adrien Hodonou
- Department of General Surgery, University and Regional Hospital Center of Borgou, Parakou, Republic of Benin
| | - Martin Hutan
- Chirurgische Abteilung, Landesklinikum Hainburg, Hainburg an der Donau, Austria
| | - Igor Ilaschuk
- Intensive Care Unit, Chernivtsi City Emergency Hospital, Chernivtsi, Ukraine
| | - Orestis Ioannidis
- 0000000109457005grid.4793.94th Surgical Department, Medical School, Aristotle University of Thessaloniki, General Hospital “G. Papanikolaou”, Thessaloniki, Greece
| | - Arda Isik
- 0000 0001 1498 7262grid.412176.7Department of General Surgery, Erzincan University Hospital, Erzincan, Turkey
| | - Georgy Ivakhov
- 0000 0000 9559 0613grid.78028.35Department of Faculty Surgery #1, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Sumita Jain
- grid.416065.0Department of Surgery, SMS Hospital, Jaipur, India
| | - Mantas Jokubauskas
- 0000 0004 0575 8750grid.48349.32Department of Surgery, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Aleksandar Karamarkovic
- Faculty of Medicine University of Belgrade Clinic for Surgery, University Clinical Center “Zvezdara”, Belgrade, Serbia
| | - Robin Kaushik
- 0000 0004 1767 2831grid.413220.6Department of General Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Jakub Kenig
- 0000 0001 2162 9631grid.5522.0Department of General, Oncologic and Geriatric Surgery, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Denis Khokha
- Department of Vascular Surgery, City Hospital, Mozyr, Belarus
| | - Jae Il Kim
- 0000 0004 0371 8173grid.411633.2Department of Surgery, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Victor Kong
- 0000 0004 0576 7753grid.414386.cTrauma and Acute Care Surgery, Edendale Hospital, Pietermaritzburg, South Africa
| | - Dimitris Korkolis
- Department of Surgery, Saint Savvas Anticancer Hospital, Athens, Greece
| | - Vitor F. Kruger
- 0000 0001 0723 2494grid.411087.bDivision of Trauma Surgery, Hospital de Clinicas, University of Campinas, Campinas, Brazil
| | - Ashok Kshirsagar
- Department of Surgery, Krishna Hospital and Medical Research University Karad, Karad, India
| | - Romeo Lages Simões
- Departament of General Surgery, Hospital Municipal de Governador Valadares, Vale do Rio Doce University, Governador Valadares, Brazil
| | - Andrea Lanaia
- Chirurgia d’Urgenza, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | | | - Pedro Leão
- 0000 0001 2159 175Xgrid.10328.38Cirurgia Geral, Hospital de Braga, Life and Health Sciences Research Institute, ICVS/3Bs, Universidade do Minho, Braga, Portugal
| | - Miguel León Arellano
- grid.419651.eGeneral and Digestive Surgery, Hospital Fundación Jimenez Diaz, Madrid, Spain
| | - Holger Listle
- 0000 0000 9116 8976grid.412469.cGeneral, Visceral, Thoracic and Vascular Surgery, University Hospital Greifswald, Greifswald, Germany
| | - Andrey Litvin
- 0000 0001 1018 9204grid.410686.dDepartment of Surgical Disciplines, Regional Clinical Hospital, Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Aintzane Lizarazu Pérez
- grid.414651.3Cirugía general y del aparato digestivo, Hospital Universitario Donostia, Donostia, Spain
| | | | | | - Davide Luppi
- Department of General and Emergency Surgery, ASMN Reggio Emilia, Modena, Italy
| | - Gustavo M. Machain V
- 0000 0001 2289 5077grid.412213.7II Catedra de Clinica Quirúrgica, Hospital de Clinicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay
| | - Piotr Major
- 0000 0001 2162 9631grid.5522.02nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Dimitrios Manatakis
- 0000 0004 0638 8093grid.414025.6Department of Surgery, Athens Naval and Veterans Hospital, Athens, Greece
| | - Marianne Marchini Reitz
- 0000 0001 0084 1895grid.411409.9Division of Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, USA
| | - Athanasios Marinis
- grid.417374.2First Department of Surgery, Tzaneio General Hospital, Piraeus, Greece
| | - Daniele Marrelli
- 0000 0004 1757 4641grid.9024.fDepartment of General Surgery and Surgical Oncology, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Aleix Martínez-Pérez
- 0000 0004 1770 9825grid.411289.7Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Sanjay Marwah
- 0000 0004 1771 1642grid.412572.7Department of General Surgery, Post-graduate Institute of Medical Sciences, Rohtak, India
| | - Michael McFarlane
- 0000 0004 0500 5353grid.412963.bDepartment of Surgery, Radiology, Anaesthesia and Intensive Care, University Hospital of the West Indies, Kingston, Jamaica
| | - Mirza Mesic
- 0000 0001 0682 9061grid.412410.2Department of Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Cristian Mesina
- grid.452359.cSecond Surgical Clinic, Emergency County Hospital of Craiova, Craiova, Romania
| | - Nickos Michalopoulos
- 0000 0004 0576 4544grid.411222.63rd Department of Surgery, Ahepa University Hospital, Thessaloniki, Greece
| | - Evangelos Misiakos
- 0000 0004 0622 4662grid.411449.d3rd Department of Surgery, Attikon University Hospital, Athens, Greece
| | - Felipe Gonçalves Moreira
- Departament of General Surgery, Hospital Municipal de Governador Valadares, Vale do Rio Doce University, Governador Valadares, Brazil
| | - Ouadii Mouaqit
- grid.412817.9Department of Surgery, Hassan II, Fez, Morocco
| | - Ali Muhtaroglu
- 0000 0001 0682 3030grid.49746.38Department of General Surgery, Sakarya University Research and Educational Hospital, Sakarya, Turkey
| | - Noel Naidoo
- Department of Specialist Surgery, Port Shepstone Regional Hospital, Port Shepstone, Republic of South Africa
| | - Ionut Negoi
- General Surgery Department, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Zane Nikitina
- 0000 0004 0375 2558grid.488518.8Toxicology and Sepsis, Riga East University Hospital, Riga, Latvia
| | - Ioannis Nikolopoulos
- grid.439484.6Department of General Surgery, Queen Elizabeth Hospital, London, UK
| | - Gabriela-Elisa Nita
- grid.458453.bChirurgia generale, Sant’Anna (AUSL Reggio Emilia), Castelnovo ne’ Monti, Italy
| | | | - Iyiade Olaoye
- 0000 0000 8878 5287grid.412975.cDepartment of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Carlos A. Ordoñez
- 0000 0001 2295 7397grid.8271.cDepartment of Surgery, Fundacion Valle del Lili - Universidad del Valle, Cali, Colombia
| | - Zeynep Ozkan
- Department of General Surgery, University of Health Sciences, Elazig Training and Research Hospital, Elazig, Turkey
| | - Ajay Pal
- 0000 0004 0645 6578grid.411275.4Department of Surgery, King George’s Medical University, Lucknow, India
| | - Gian M. Palini
- grid.414614.2Chirurgia Generale e d’Urgenza, Ospedale Infermi, Rimini, Italy
| | | | - Dimitris Papagoras
- Department of General Surgery, General Hospital of Trikala, Trikala, Greece
| | - Francesco Pata
- Department of Surgery, Sant’Antonio Abate Hospital, Gallarate, Italy
| | - Michał Pędziwiatr
- 0000 0001 1216 0093grid.412700.0Department of General and Emergency Surgery, University Hospital, University Hospital Kraków, Kraków, Poland
| | - Jorge Pereira
- 0000 0004 5914 1131grid.489946.eCirurgia Geral, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | | | - Gennaro Perrone
- Chirurgia d’Urgenza – Dipartimento Urgenza/Emergenza, AOU Parma, Parma, Italy
| | - Tadeja Pintar
- 0000 0004 0571 7705grid.29524.38Department of Abdominal Surgery, UMC Ljubljana, Ljubljana, Slovenia
| | - Magdalena Pisarska
- 0000 0001 1216 0093grid.412700.0Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, University Hospital, Kraków, Poland
| | - Oleksandr Plehutsa
- Surgery Department, Chernivtsi City Emergency Hospital, Chernivtsi, Ukraine
| | - Mauro Podda
- Department of General, Emergency and Robotic Surgery, San Francesco Hospital, Nuoro, Italy
| | | | - Martha Quiodettis
- 0000 0004 0465 2778grid.461067.2Department of Surgery/Trauma, Hospital Santo Tomás, Panama, Panama
| | - Tuba Rahim
- 0000 0001 0723 4123grid.16463.36Department of Trauma ICU, IALCH, University of KwaZulu-Natal, Durban, South Africa
| | - Daniel Rios-Cruz
- Department of Gastrointestinal Surgery, HGR1 IMSS, Cuernavaca, Mexico
| | - Gabriel Rodrigues
- 0000 0001 0571 5193grid.411639.8Department of General Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Dmytry Rozov
- 0000 0000 9950 8111grid.413731.3Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Boris Sakakushev
- 0000 0001 1014 775Xgrid.11187.3eFirst Clinic of General Surgery, University Hospital St George/Medical University Plovdiv, Plovdiv, Bulgaria
| | - Ibrahima Sall
- grid.414281.aChirurgie Générale et Viscérale, Hôpital d’instruction des Armées, Hôpital Principal de Dakar, Dakar, Senegal
| | - Alexander Sazhin
- 0000 0000 9559 0613grid.78028.35Department of Faculty Surgery #1, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Miguel Semião
- Cirurgia Geral, Centro Hospitalar Universitário da Cova da Beira, Covilhã, Portugal
| | - Taanya Sharda
- 0000 0004 1767 2831grid.413220.6Department of General Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Vishal Shelat
- grid.240988.fDepartment of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Giovanni Sinibaldi
- Department of Surgery, Fatebbenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Dmitrijs Skicko
- 0000 0004 0375 2558grid.488518.8Department of Surgery (Department No. 10), Riga East Clinical University Hospital “Gaiļezers”, Riga, Latvia
| | - Matej Skrovina
- Department of Surgery, Hospital and Oncological Centre Novy Jicin, Novy Jicin, Czech Republic
| | - Dimitrios Stamatiou
- 0000 0004 0399 7344grid.413964.dGeneral Surgery, Heartlands Hospital, Birmingham, UK
| | - Marco Stella
- grid.414126.4Department of Surgery, San Carlo Borromeo Hospital, Milan, Italy
| | - Marcin Strzałka
- 0000 0001 2162 9631grid.5522.0Department of General Surgery, Polytrauma and Emergency Medicine, University Hospital of the Jagiellonian University Medical College, Kraków, Poland
| | - Ruslan Sydorchuk
- 0000 0004 4906 2392grid.445372.3General Surgery Department, Bukovinian State Medical University, Chernivtsi, Ukraine
| | | | - Joel Noutakdie Tochie
- 0000 0001 2173 8504grid.412661.6Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon and Department of Surgery and Anaesthesiology, Yaounde Central Hospital, Yaounde, Cameroon
| | - Gia Tomadze
- 0000 0004 0428 8304grid.412274.6Surgery Department, Tbilisi State Medical University, Tbilisi, Georgia
| | - Lara Ugoletti
- Chirurgia Generale, Ospedale Civile di Guastalla, Reggio Emilia, Italy
| | - Jan Ulrych
- 0000 0000 9100 9940grid.411798.2First Department of Surgery, Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Toomas Ümarik
- 0000 0004 0631 377Xgrid.454953.aUpper Gastrointestinal Tract Surgery Department, North Estonia Medical Centre, Tallinn, Estonia
| | | | - Alin Vasilescu
- First Surgical Unit, “St. Spiridon” University Hospital Iasi, University of Medicine and Pharmacy “Grigore T. Popa”, Iasi, Romania
| | - Osborne Vaz
- 0000 0004 0641 2823grid.419319.7Renal Transplant and General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - Andras Vereczkei
- 0000 0001 0663 9479grid.9679.1Department of Surgery, Clinical Center University of Pecs, Pecs, Hungary
| | - Nutu Vlad
- First Surgical Unit, “St. Spiridon” University Hospital Iasi, University of Medicine and Pharmacy “Grigore T. Popa”, Iasi, Romania
| | - Maciej Walędziak
- 0000 0004 0620 0839grid.415641.3Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Ali I. Yahya
- Department of Surgey, Zliten Teaching Hospital, Zliten, Libya
| | - Omer Yalkin
- 0000000109409118grid.7256.6Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Tonguç U. Yilmaz
- grid.488402.2Transplantation Unıt, Acibadem Atakent Hospital, İstanbul, Turkey
| | - Ali Ekrem Ünal
- 0000000109409118grid.7256.6Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Kuo-Ching Yuan
- 0000 0004 0639 0994grid.412897.1Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sanoop K. Zachariah
- 0000 0004 1766 361Xgrid.464618.9Department of Surgery, Mosc Medical College, Kolenchery, Cochin, India
| | - Justas Žilinskas
- Faculty of Medicine University of Belgrade Clinic for Surgery, University Clinical Center “Zvezdara”, Belgrade, Serbia
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Vittoria Pattonieri
- grid.411482.aEmergency Surgery Department, Maggiore Parma Hospital, Parma, Italy
| | - Gian Luca Baiocchi
- 0000000417571846grid.7637.5Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fausto Catena
- grid.411482.aEmergency Surgery Department, Maggiore Parma Hospital, Parma, Italy
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Abdel-Kader S, Sartelli M, Abu-Zidan FM. Complicated intra-abdominal infections: a prospective validation study of the WSES Sepsis Severity Score. Singapore Med J 2018; 60:317-321. [PMID: 30311628 DOI: 10.11622/smedj.2018120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The World Society of Emergency Surgery (WSES) recently developed and validated a sepsis severity score for complicated intra-abdominal infections (cIAIs). We aimed to prospectively study the validity of this score in our local setting and compare it with global findings. METHODS In a prospective study of 100 consecutive adult patients with cIAIs treated at Al-Ain Hospital, United Arab Emirates, from October 2014 to January 2016, we studied patients' demographics, disease, risk factors, WSES Sepsis Severity Score, management, hospital stay and mortality. Our findings were compared with those from a recent global multicentre prospective study from 53 countries (n = 4,496). RESULTS Compared with global data, our patients were more likely to be male (p < 0.0001) and younger (p < 0.0001), with more appendicitis and perforated peptic ulcers (p < 0.0001), significantly lower sepsis severity score (p < 0.0001) and more delays in surgical intervention (p = 0.001). Nevertheless, they had similar adequate source control (p = 0.54) and surgical reinterventions (p = 0.63). Overall, our patients had a significantly lower mortality rate (1.0% vs. 9.3% in global data; p = 0.001). A direct logistic regression model showed that the WSES Sepsis Severity Score significantly predicted mortality (p < 0.0001), but our hospital's setting was not predictive of mortality compared with other hospitals (p = 0.18). CONCLUSION Although our patient demographics and hospital's setting significantly differed from those of other international hospitals, the WSES Sepsis Severity Score was very accurate in predicting mortality among our patients, which supports its generalisability for all patient populations worldwide.
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Affiliation(s)
- Saleh Abdel-Kader
- Department of Surgery, Al-Ain Hospital, Al-Ain, United Arab Emirates
| | | | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
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6
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Mazuski JE, Tessier JM, May AK, Sawyer RG, Nadler EP, Rosengart MR, Chang PK, O'Neill PJ, Mollen KP, Huston JM, Diaz JJ, Prince JM. The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection. Surg Infect (Larchmt) 2017; 18:1-76. [PMID: 28085573 DOI: 10.1089/sur.2016.261] [Citation(s) in RCA: 328] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Previous evidence-based guidelines on the management of intra-abdominal infection (IAI) were published by the Surgical Infection Society (SIS) in 1992, 2002, and 2010. At the time the most recent guideline was released, the plan was to update the guideline every five years to ensure the timeliness and appropriateness of the recommendations. METHODS Based on the previous guidelines, the task force outlined a number of topics related to the treatment of patients with IAI and then developed key questions on these various topics. All questions were approached using general and specific literature searches, focusing on articles and other information published since 2008. These publications and additional materials published before 2008 were reviewed by the task force as a whole or by individual subgroups as to relevance to individual questions. Recommendations were developed by a process of iterative consensus, with all task force members voting to accept or reject each recommendation. Grading was based on the GRADE (Grades of Recommendation Assessment, Development, and Evaluation) system; the quality of the evidence was graded as high, moderate, or weak, and the strength of the recommendation was graded as strong or weak. Review of the document was performed by members of the SIS who were not on the task force. After responses were made to all critiques, the document was approved as an official guideline of the SIS by the Executive Council. RESULTS This guideline summarizes the current recommendations developed by the task force on the treatment of patients who have IAI. Evidence-based recommendations have been made regarding risk assessment in individual patients; source control; the timing, selection, and duration of antimicrobial therapy; and suggested approaches to patients who fail initial therapy. Additional recommendations related to the treatment of pediatric patients with IAI have been included. SUMMARY The current recommendations of the SIS regarding the treatment of patients with IAI are provided in this guideline.
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Affiliation(s)
- John E Mazuski
- 1 Department of Surgery, Washington University School of Medicine , Saint Louis, Missouri
| | | | - Addison K May
- 3 Department of Surgery, Vanderbilt University , Nashville, Tennessee
| | - Robert G Sawyer
- 4 Department of Surgery, University of Virginia , Charlottesville, Virginia
| | - Evan P Nadler
- 5 Division of Pediatric Surgery, Children's National Medical Center , Washington, DC
| | - Matthew R Rosengart
- 6 Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Phillip K Chang
- 7 Department of Surgery, University of Kentucky , Lexington, Kentucky
| | | | - Kevin P Mollen
- 9 Division of Pediatric Surgery, Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Jared M Huston
- 10 Department of Surgery, Hofstra Northwell School of Medicine , Hempstead, New York
| | - Jose J Diaz
- 11 Department of Surgery, University of Maryland School of Medicine , Baltimore, Maryland
| | - Jose M Prince
- 12 Departments of Surgery and Pediatrics, Hofstra-Northwell School of Medicine , Hempstead, New York
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7
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Sartelli M, Abu-Zidan FM, Catena F, Griffiths EA, Di Saverio S, Coimbra R, Ordoñez CA, Leppaniemi A, Fraga GP, Coccolini F, Agresta F, Abbas A, Abdel Kader S, Agboola J, Amhed A, Ajibade A, Akkucuk S, Alharthi B, Anyfantakis D, Augustin G, Baiocchi G, Bala M, Baraket O, Bayrak S, Bellanova G, Beltràn MA, Bini R, Boal M, Borodach AV, Bouliaris K, Branger F, Brunelli D, Catani M, Che Jusoh A, Chichom-Mefire A, Cocorullo G, Colak E, Costa D, Costa S, Cui Y, Curca GL, Curry T, Das K, Delibegovic S, Demetrashvili Z, Di Carlo I, Drozdova N, El Zalabany T, Enani MA, Faro M, Gachabayov M, Giménez Maurel T, Gkiokas G, Gomes CA, Gonsaga RAT, Guercioni G, Guner A, Gupta S, Gutierrez S, Hutan M, Ioannidis O, Isik A, Izawa Y, Jain SA, Jokubauskas M, Karamarkovic A, Kauhanen S, Kaushik R, Kenig J, Khokha V, Kim JI, Kong V, Koshy R, Krasniqi A, Kshirsagar A, Kuliesius Z, Lasithiotakis K, Leão P, Lee JG, Leon M, Lizarazu Pérez A, Lohsiriwat V, López-Tomassetti Fernandez E, Lostoridis E, Mn R, Major P, Marinis A, Marrelli D, Martinez-Perez A, Marwah S, McFarlane M, Melo RB, Mesina C, Michalopoulos N, Moldovanu R, Mouaqit O, Munyika A, Negoi I, Nikolopoulos I, Nita GE, Olaoye I, Omari A, Ossa PR, Ozkan Z, Padmakumar R, Pata F, Pereira Junior GA, Pereira J, Pintar T, Pouggouras K, Prabhu V, Rausei S, Rems M, Rios-Cruz D, Sakakushev B, Sánchez de Molina ML, Seretis C, Shelat V, Simões RL, Sinibaldi G, Skrovina M, Smirnov D, Spyropoulos C, Tepp J, Tezcaner T, Tolonen M, Torba M, Ulrych J, Uzunoglu MY, van Dellen D, van Ramshorst GH, Vasquez G, Venara A, Vereczkei A, Vettoretto N, Vlad N, Yadav SK, Yilmaz TU, Yuan KC, Zachariah SK, Zida M, Zilinskas J, Ansaloni L. Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study). World J Emerg Surg 2015; 10:61. [PMID: 26677396 PMCID: PMC4681030 DOI: 10.1186/s13017-015-0055-0] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 12/10/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression. METHODS The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study. RESULTS Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p < 0.0001). The multivariate logistic regression model was highly significant (p < 0.0001, R2 = 0.54) and showed that all these factors were independent in predicting mortality of sepsis. Receiver Operator Curve has shown that the WSES Severity Sepsis Score had an excellent prediction for mortality. A score above 5.5 was the best predictor of mortality having a sensitivity of 89.2 %, a specificity of 83.5 % and a positive likelihood ratio of 5.4. CONCLUSIONS WSES Sepsis Severity Score for patients with complicated Intra-abdominal infections can be used on global level. It has shown high sensitivity, specificity, and likelihood ratio that may help us in making clinical decisions.
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Affiliation(s)
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Fausto Catena
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
| | - Ewen A. Griffiths
- General and Upper GI Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Raul Coimbra
- Department of Surgery, UC San Diego Medical Center, San Diego, USA
| | | | - Ari Leppaniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - Gustavo P. Fraga
- Division of Trauma Surgery, Hospital de Clinicas, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Federico Coccolini
- General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Asrhaf Abbas
- Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Saleh Abdel Kader
- Department of General Surgery, Al Ain Hospital, Al-Ain City, United Arab Emirates
| | - John Agboola
- Department of Surgery, Kwara State General Hospital, Ilorin, Nigeria
| | - Adamu Amhed
- Department of Surgery, Ahmadu Bello University Teaching Hospital Zaria, Kaduna, Nigeria
| | - Adesina Ajibade
- Department of Surgery, LAUTECH Teaching Hospital, Osogbo, Nigeria
| | - Seckin Akkucuk
- Department of General Surgery, Training and Research Hospital of Mustafa Kemal University, Hatay, Turkey
| | - Bandar Alharthi
- Depatment of Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Goran Augustin
- Department of Surgery, University Hospital Center, Zagreb, Croatia
| | - Gianluca Baiocchi
- Clinical and Experimental Surgery, Brescia Civil Hospital, Brescia, Italy
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Savas Bayrak
- Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
| | | | - Marcelo A. Beltràn
- Department of General Surgery, Hospital San Juan de Dios de La Serena, La Serena, Chile
| | - Roberto Bini
- Department of General and Emergency Surgery, SG Bosco Hospital, Turin, Italy
| | - Matthew Boal
- General and Upper GI Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Andrey V. Borodach
- Emergency Surgery Department, 1st Municipal Hospital, Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | | | | | - Daniele Brunelli
- Chirurgia Generale, Ospedale di Città di Castello, Città di Castello, Italy
| | - Marco Catani
- Department of Emergency Surgery, Umberto I Hospital, “La Sapienza” University, Rome, Italy
| | - Asri Che Jusoh
- Department of Surgery, Kuala Krai Hospital, Kelantan, Malaysia
| | | | | | - Elif Colak
- Department of General Surgery, Samsun Education and Research Hospital, Samsun, Turkey
| | - David Costa
- Department of General and Digestive Tract Surgery, Alicante University General Hospital, Alicante, Spain
| | - Silvia Costa
- Department of Surgery, CHVNG/E, EPE, Vila Nova de Gaia, Portugal
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Tianjin, China
| | - Geanina Loredana Curca
- Department of General Surgery, Emergency Municipal Hospital Pascani, Pascani, Iasi Romania
| | - Terry Curry
- Department of Surgery, UC San Diego Medical Center, San Diego, USA
| | - Koray Das
- Department of Surgery, Numune Training and Research Hospital, Adana, Turkey
| | - Samir Delibegovic
- Department of Surgery, University Clinical Center, Tuzla, Bosnia and Herzegovina
| | - Zaza Demetrashvili
- Department General Surgery, Kipshidze Central University Hospital, Tbilisi, Georgia
| | | | - Nadezda Drozdova
- Department of Surgery, Riga East Clinical University Hospital, Riga, Latvia
| | - Tamer El Zalabany
- Department of Surgery, Bahrain Defence Force Hospital, Manama, Bahrain
| | | | - Mario Faro
- Division of General and Emergency Surgery, Hospital Estadual Mario Covas, ABC School of Medicine, Santo André, Brazil
| | - Mahir Gachabayov
- Department of Surgery 1, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russian Federation
| | | | - Georgios Gkiokas
- 2nd Department of Surgery, Aretaieio University Hospital, Athens, Greece
| | - Carlos Augusto Gomes
- Department of Surgery, Hospital Universitário Terezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, Brazil
| | | | | | - Ali Guner
- Department of General Surgery, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Sanjay Gupta
- Department of Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Sandra Gutierrez
- Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia
| | - Martin Hutan
- 2nd Surgical Department of Medical Faculty Comenius University, University Hospital Bratislava, Bratislava, Slovakia
| | | | - Arda Isik
- Department of Surgery, Mengucek Gazi Training Research Hospital, Erzincan, Turkey
| | - Yoshimitsu Izawa
- Department of Emergency and Critical Care Medicine, Jichi Medical University, Shimotsuke, Japan
| | | | - Mantas Jokubauskas
- Department of Surgery, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Saila Kauhanen
- Division Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Robin Kaushik
- Department of Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Jakub Kenig
- 3rd Department of General Surgery, Jagiellonian Univeristy Collegium Medium, Kraków, Poland
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Jae Il Kim
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Victor Kong
- Department of Surgery, Edendale Hospital, Pietermaritzburg, South Africa
| | - Renol Koshy
- Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Avidyl Krasniqi
- Department of Surgery, University Clinical Center of Kosovo, Pristina, Kosovo
| | | | - Zygimantas Kuliesius
- Department of General Surgery, Republican Vilnius University Hospital, Vilnius, Lithuania
| | | | - Pedro Leão
- General Surgery/Coloretal Unit, Braga Hospital, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - Jae Gil Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Miguel Leon
- Department of Surgery, Hospital La Paz, Madrid, Spain
| | | | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Raghuveer Mn
- Department of General Surgery, Mysore Medical College and Research Institute, Government Medical College Hospital Mysore, Mysore, India
| | - Piotr Major
- 2nd Department of Surgery, Jagiellonian University Medical College, Krakow, Poland
| | | | - Daniele Marrelli
- Department of General Surgery and Surgical Oncology, Le Scotte Hospital, Siena, Italy
| | | | - Sanjay Marwah
- Department of Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Michael McFarlane
- Department of Surgery, Radiology, University Hospital of the West Indies, Kingston, Jamaica
| | - Renato Bessa Melo
- General Surgery Department, Centro Hospitalar de São João, Porto, Portugal
| | - Cristian Mesina
- Second Surgical Clinic, Emergency Hospital of Craiova, Craiova, Romania
| | - Nick Michalopoulos
- 3rd Department of Surgery, Haepa University Hospital, Thessaloniki, Greece
| | | | - Ouadii Mouaqit
- Surgery Department, University Hospital Hassan II, Fez, Morocco
| | - Akutu Munyika
- Department of Surgery, Onandjokwe Hospital, Ondangwa, Namibia
| | - Ionut Negoi
- Department of Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | | | | | - Iyiade Olaoye
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Abdelkarim Omari
- Department of Surgery, King Abdalla University Hospital, Irbid, Jordan
| | | | - Zeynep Ozkan
- Department of Surgery, Elazig Training and Research Hospital, Elazig, Turkey
| | | | - Francesco Pata
- Department of Surgery, Sant’Antonio Abate Hospital, Gallarate, Italy
| | | | - Jorge Pereira
- Surgery 1 Unit, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Tadeja Pintar
- Department of Surgery, UMC Ljubljana, Ljubljana, Slovenia
| | | | - Vinod Prabhu
- Department of Surgery, Bharati Medical College and Hospital, Sangli, India
| | - Stefano Rausei
- Department of Surgery, Insubria University Hospital, Varese, Italy
| | - Miran Rems
- Abdominal and General Surgery Department, General Hospital Jesenice, Jesenice, Slovenia
| | - Daniel Rios-Cruz
- Department of Surgery, Hospital de Alta Especialidad de Veracruz, Veracruz, Mexico
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | | | - Charampolos Seretis
- Department of Surgery, Good Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Vishal Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Novena, Singapore
| | - Romeo Lages Simões
- Division of Trauma Surgery, Hospital de Clinicas, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Giovanni Sinibaldi
- Departement of Surgery, Fatabenefratelli Isola Tiberina Hspital, Rome, Italy
| | - Matej Skrovina
- Department of Surgery, Hospital and Comprehensive Cancer Centre Novy Jicin, Novy Jicin, Czech Republic
| | - Dmitry Smirnov
- Department of General Surgery, Clinical Hospital at Chelyabinsk Station of OJSC “Russian Railroads”, Chelyabinsk, Russian Federation
| | | | - Jaan Tepp
- Department of Surgery, North Estonia Medical Center, Tallin, Estonia
| | - Tugan Tezcaner
- Department of Surgery, Baskent University Ankara Hospital, Ankara, Turkey
| | - Matti Tolonen
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - Myftar Torba
- General Surgery Service, Trauma University Hospital, Tirana, Albania
| | - Jan Ulrych
- 1st Department of Surgery - Department of Abdominal, Thoracic Surgery and Traumatology, General University Hospital, Prague, Czech Republic
| | | | - David van Dellen
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester, UK
| | | | - Giorgio Vasquez
- Emergency Surgery, Arcispedale S.Anna Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | | | - Andras Vereczkei
- Department of Surgery, Medical School University Pecs, Pecs, Hungary
| | - Nereo Vettoretto
- Department of Surgery, Montichiari Hospital, Ospedali Civili Brescia, Brescia, Italy
| | - Nutu Vlad
- 1st Surgical Clinic, St. Spiridon Hospital, Iasi, Romania
| | - Sanjay Kumar Yadav
- Department of Surgery, Rajendra Institute of Medical Sciences, Ranchi, India
| | - Tonguç Utku Yilmaz
- Department of Surgery, Kocaeli University Training and Research Hospital, Kocaeli, Turkey
| | - Kuo-Ching Yuan
- Trauma and Emergency Surgery Department, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | | | - Maurice Zida
- General and Digestive Surgery Department, Teaching Hospital Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - Justas Zilinskas
- Department of Surgery, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Luca Ansaloni
- General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Sartelli M, Catena F, Di Saverio S, Ansaloni L, Malangoni M, Moore EE, Moore FA, Ivatury R, Coimbra R, Leppaniemi A, Biffl W, Kluger Y, Fraga GP, Ordonez CA, Marwah S, Gerych I, Lee JG, Tranà C, Coccolini F, Corradetti F, Kirkby-Bott J. Current concept of abdominal sepsis: WSES position paper. World J Emerg Surg 2014; 9:22. [PMID: 24674057 PMCID: PMC3986828 DOI: 10.1186/1749-7922-9-22] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 02/25/2014] [Indexed: 12/19/2022] Open
Abstract
Although sepsis is a systemic process, the pathophysiological cascade of events may vary from region to region. Abdominal sepsis represents the host’s systemic inflammatory response to bacterial peritonitis. It is associated with significant morbidity and mortality rates, and is the second most common cause of sepsis-related mortality in the intensive care unit. The review focuses on sepsis in the specific setting of severe peritonitis.
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Abstract
Intraabdominal infections are frequent and dangerous entity in intensive care units. Mortality and morbidity are high, causes are numerous, and treatment options are variable. The intensivist is challenged to recognize and treat intraabdominal infections in a timely fashion to prevent complications and death. Diagnosis of intraabdominal infection is often complicated by confounding underlying disease or masked by overall comorbidity. Current research describes a wide heterogeneity of patient populations, making it difficult to suggest a general treatment regimen and stressing the need of an individualized approach to decision making. Early focus-oriented intervention and antibiotic coverage tailored to the individual patient and hospital is warranted.
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Affiliation(s)
| | - Mitchell Cahan
- Department of Surgery, University of Massachusetts Medical School, MA, USA
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Chow AW, Evans GA, Nathens AB, Ball CG, Hansen G, Harding GKM, Kirkpatrick AW, Weiss K, Zhanel GG. Canadian practice guidelines for surgical intra-abdominal infections. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2010; 21:11-37. [PMID: 21358883 PMCID: PMC2852280 DOI: 10.1155/2010/580340] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Anthony W Chow
- Division of Infectious Disease, Department of Medicine, University of British Columbia and Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia
| | - Gerald A Evans
- Division of Infectious Diseases, Department of Medicine, Queen’s University, Kingston
| | - Avery B Nathens
- Department of Surgery, University of Toronto, Toronto, Ontario
| | - Chad G Ball
- Department of Surgery, University of Calgary, Calgary, Alberta
| | - Glen Hansen
- Departments of Pathology and Laboratory Medicine, University of Minnesota and Hennepin County Medical Center, Minnesota, USA
| | - Godfrey KM Harding
- Department of Medical Microbiology and Medicine, University of Manitoba, Winnipeg, Manitoba
| | | | - Karl Weiss
- Department of Infectious Diseases and Microbiology, Hôspital Maisonneuve-Rosemont, University of Montreal, Montreal, Quebec
| | - George G Zhanel
- Department of Medical Microbiology and Medicine, University of Manitoba, Winnipeg, Manitoba
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Inui T, Haridas M, Claridge JA, Malangoni MA. Mortality for intra-abdominal infection is associated with intrinsic risk factors rather than the source of infection. Surgery 2009; 146:654-61; discussion 661-2. [PMID: 19789024 DOI: 10.1016/j.surg.2009.06.051] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 06/25/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND Intra-abdominal infections (IAIs) are an important cause of mortality and morbidity. Nosocomial IAIs (NIAIs) have been associated with higher mortality than community-acquired IAIs (CIAIs). We hypothesized that intrinsic risk factors were a better predictor of mortality than the type of infection. METHODS Patients with IAI treated at a single urban academic hospital over 8 years (June 1999-June 2007) were retrospectively reviewed. Data collected included demographics, comorbidities, source of infection, type of infection (community vs nosocomial), type of intervention (operation versus percutaneous drainage), and postoperative complications. Charlson Comorbidity Index and multiple organ dysfunction (MOD) scores were evaluated at admission and on postoperative day 7 (POD-7). RESULTS There were 452 patients; 234 (51.8%) had CIAI and 218 (48.2%) had NIAI. The mean age was 51.3 +/- 0.8. The most common source of CIAI was the appendix (n = 129, 28.5%); 137 patients with NIAI had postoperative infections (30.3%). When patients with appendicitis were excluded, there was no difference in mortality or complications between patients with CIAI and NIAI. Logistic regression analysis demonstrated catheter-related bloodstream infection (P < .001; OR 7.3, 95% CI, 2.5-22.2), cardiac event (P < .001; OR 6.0, 95% CI, 2.3-16.1), and age > or = 65 (P = .009; OR 3.8, 95% CI, 1.4-8.8) to be independent risk factors for mortality. Among patients who failed initial therapy, a non-appendiceal source of infection (P < .001; OR 4.7, 95% CI, 2.3-9.8) and a Charlson score > or =2 (P = .033; OR 1.6, 95% CI, 1.0-2.6) were determined to be independent risk factors. Non-appendiceal source of infection (P = .001, OR 3.3, 95% CI, 1.6-7.0) and POD-7 MOD score > or =4 (P < .001; OR 3.4, 95% CI, 1.9-6.0) were found to be independent predictors for re-intervention. CONCLUSION These results suggest mortality from IAI is strongly related to age and organ dysfunction; however, catheter-related bloodstream infection and postoperative cardiac events have a greater effect on outcome.
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Affiliation(s)
- Tazo Inui
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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13
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Vist GE, Bryant D, Somerville L, Birminghem T, Oxman AD. Outcomes of patients who participate in randomized controlled trials compared to similar patients receiving similar interventions who do not participate. Cochrane Database Syst Rev 2008; 2008:MR000009. [PMID: 18677782 PMCID: PMC8276557 DOI: 10.1002/14651858.mr000009.pub4] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Some people believe that patients who take part in randomised controlled trials (RCTs) face risks that they would not face if they opted for non-trial treatment. Others think that trial participation is beneficial and the best way to ensure access to the most up-to-date physicians and treatments. This is an updated version of the original Cochrane review published in Issue 1, 2005. OBJECTIVES To assess the effects of patient participation in RCTs ('trial effects') independent both of the effects of the clinical treatments being compared ('treatment effects') and any differences between patients who participated in RCTs and those who did not. We aimed to compare similar patients receiving similar treatment inside and outside of RCTs. SEARCH STRATEGY In March 2007, we searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, The Cochrane Methodology Register, SciSearch and PsycINFO for potentially relevant studies. Our search yielded 7586 new references. In addition, we reviewed the reference lists of relevant articles. SELECTION CRITERIA Randomized studies and cohort studies with data on clinical outcomes of RCT participants and similar patients who received similar treatment outside of RCTs. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed studies for inclusion, assessed study quality and extracted data. MAIN RESULTS We identified 30 new non-randomized cohort studies (45 comparisons): no new RCTs were found. This update now includes five RCTs (yielding 6 comparisons) and 80 non-randomized cohort studies (130 comparisons), with 86,640 patients treated in RCTs and 57,205 patients treated outside RCTs. In the randomised studies, patients were invited to participate in an RCT or not; these comparisons provided limited information because of small sample sizes (a total of 412 patients) and the nature of the questions they addressed. When the results of RCTs and non-randomized cohorts that reported dichotomous outcomes were combined, there were 98 comparisons; there was also heterogeneity (P < 0.00001, I(2) = 42.2%) between studies. No statistical significant differences were found for 85 of the 98 comparisons. Eight comparisons reported statistically significant better outcomes for patients treated within RCTs, and five comparisons reported statistically significant worse outcomes for patients treated within RCTs. There was significant heterogeneity (P < 0.00001, I(2) = 58.2%) among the 38 continuous outcome comparisons. No statistically significant differences were found for 30 of the 38 comparisons. Three comparisons reported statistically significant better outcomes for patients treated within RCTs, and five comparisons reported statistically significant worse outcomes for patients treated within RCTs. AUTHORS' CONCLUSIONS This review indicates that participation in RCTs is associated with similar outcomes to receiving the same treatment outside RCTs. These results challenge the assertion that the results of RCTs are not applicable to usual practice.
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Affiliation(s)
- Gunn Elisabeth Vist
- Department of Evidence-Based Health Services, Norwegian Knowledge Centre for Health Services, PO Box 7004, St Olavs Plass, Oslo, Norway, 0130.
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14
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Update on intra-abdominal and post-surgical infections. Enferm Infecc Microbiol Clin 2008. [DOI: 10.1016/s0213-005x(08)76379-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Treatment of patients with complicated intra-abdominal infections involves antimicrobial therapy, generally in conjunction with an interventional procedure to control the source of the infection. Antimicrobial regimens effective against common gram-negative and anaerobic enteric pathogens are the mainstay of therapy. For patients with community-acquired intra-abdominal infections, efficacy is comparable among the various single-agent or combination regimens recommended for therapy. Narrower-spectrum antimicrobial agents with a low potential for iatrogenic complications are appropriate for these patients. Patients with nosocomially-acquired, intra-abdominal infections are more likely to harbor resistant pathogens. Inadequate empiric antimicrobial therapy is associated with treatment failure and death. Therefore, broader spectrum antimicrobial regimens are recommended for these patients. In addition to coverage of more resistant gram-negative bacilli and anaerobes, use of agents effective against enterococci, resistant staphylococci and Candida should be considered. De-escalation of an initially broad antimicrobial regimen should be undertaken once definitive culture results are available.
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Affiliation(s)
- John E Mazuski
- Washington University School of Medicine, Department of Surgery, Campus Box 8109, 660 S. Euclid Avenue, Saint Louis, Missouri 63110-1093, USA.
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16
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Vist GE, Hagen KB, Devereaux PJ, Bryant D, Kristoffersen DT, Oxman AD. Outcomes of patients who participate in randomised controlled trials compared to similar patients receiving similar interventions who do not participate. Cochrane Database Syst Rev 2007:MR000009. [PMID: 17443630 DOI: 10.1002/14651858.mr000009.pub3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Some people believe that patients who take part in randomised controlled trials (RCTs) face risks that they would not face if they opted for non-trial treatment. Others think that trial participation is beneficial and the best way to ensure access to the most up to date physicians and treatments. OBJECTIVES To assess the effects of patient participation in RCTs ('trial effects') independent both of the effects of the clinical treatments being compared ('treatment effects') and any differences between patients who participated in RCTs and those who did not. SEARCH STRATEGY In May 2001, we searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, The Cochrane Methodology Register, SciSearch and PsycINFO for potentially relevant studies. Our search yielded over 10,000 references. In addition, we reviewed the reference lists of relevant articles and wrote to over 250 investigators to try to obtain further information. SELECTION CRITERIA Randomised studies and cohort studies with data on clinical outcomes of RCT participants and similar patients who received similar treatment outside of RCTs. DATA COLLECTION AND ANALYSIS At least two reviewers independently assessed studies for inclusion, assessed study quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS We included five randomised studies (yielding 6 comparisons) and 50 non-randomised cohort studies (85 comparisons), with 31,140 patients treated in RCTs and 20,380 patients treated outside RCTs. In the randomised studies, patients were invited to participate in an RCT or not; these comparisons provided limited information because of small sample sizes (a total of 412 patients) and the nature of the questions they addressed. There was statistically significant heterogeneity (P < 0.002, I(2) = 36.2%) among the 73 dichotomous outcome comparisons; none of the potential explanatory factors we investigated helped to explain this heterogeneity. No statistically significant differences were found for 63 of the 73 comparisons. Eight comparisons reported statistically significant better outcomes for patients treated within RCTs, and two comparisons reported statistically significant worse outcomes for patients treated within RCTs. There were no statistically significant differences in heterogeneity (P = 0.53, I(2) = 0%) or in outcomes (SMD 0.01, 95% CI -0.10 to 0.12) of patients treated within and outside RCTs in the 18 comparisons which had used continuous outcomes. AUTHORS' CONCLUSIONS This review indicates that participation in RCTs is not associated with greater risks than receiving the same treatment outside RCTs. These results challenge the assertion that the results of RCTs are not applicable to usual practice.
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Affiliation(s)
- G E Vist
- Norwegian Knowledge Centre for Health Services, PO Box 7004, St Olavs Plass, Oslo, Norway, 0130.
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17
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Kioumis IP, Kuti JL, Nicolau DP. Intra-abdominal infections: considerations for the use of the carbapenems. Expert Opin Pharmacother 2007; 8:167-82. [PMID: 17257087 DOI: 10.1517/14656566.8.2.167] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intra-abdominal infection remains a common and frequently severe medical condition, carrying with it significant morbidity and mortality. These infections are almost always polymicrobial in nature as they are caused by mixed aerobic/anaerobic intestinal flora. Despite substantial improvements in both the medical and surgical management of these infections over the last several decades, there remains an opportunity to further enhance the utilization of adjunctive antibiotic therapy. As a result of the epidemiology and the current resistance profile of the infecting pathogens, the carbapenems represent a class of antibiotics that are considered appropriate for the treatment of severe intra-abdominal infections. This review will discuss the classification and microbiology of these infections and emerging resistance in the pathogens of interest. The review also and focuses on the role of the carbapenems in the management of the constellation of diseases known as intra-abdominal infection.
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Affiliation(s)
- Ioannis P Kioumis
- Center for Anti-infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
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18
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Malangoni MA, Inui T. Peritonitis - the Western experience. World J Emerg Surg 2006; 1:25. [PMID: 16953882 PMCID: PMC1592073 DOI: 10.1186/1749-7922-1-25] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 09/05/2006] [Indexed: 11/10/2022] Open
Abstract
Peritonitis is a common surgical emergency. This manuscript will provide an overview of recent developments in the management of peritonitis in the Western world. Emphasis is placed on the emergence of new treatments and their impact of outcomes.
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Affiliation(s)
- Mark A Malangoni
- Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Tazo Inui
- Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
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19
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Malangoni MA, Song J, Herrington J, Choudhri S, Pertel P. Randomized controlled trial of moxifloxacin compared with piperacillin-tazobactam and amoxicillin-clavulanate for the treatment of complicated intra-abdominal infections. Ann Surg 2006; 244:204-11. [PMID: 16858182 PMCID: PMC1602153 DOI: 10.1097/01.sla.0000230024.84190.a8] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the safety and efficacy of sequential intravenous (IV) to oral (PO) moxifloxacin treatment against a standard antimicrobial regimen of IV piperacillin-tazobactam followed by PO amoxicillin-clavulanate for the treatment of adults with complicated intra-abdominal infection (cIAI). SUMMARY BACKGROUND DATA cIAIs are commonly due to mixed aerobic and anaerobic bacteria and require both source control and broad-spectrum antibiotic therapy. METHODS A prospective, double-blind, randomized, phase III comparative trial. Patients with cIAI were stratified by disease severity (APACHE II score) and randomized to either IV/PO moxifloxacin (400 mg q24 hours) or comparator (IV piperacillin-tazobactam [3.0/0.375 g q6 hours] +/- PO amoxicillin-clavulanate [800 mg/114 mg q12 hours]), each for 5 to 14 days. The primary efficacy variable was clinical cure rate at the test-of-cure visit (days 25-50). Bacteriologic outcomes were also determined. RESULTS : Of 656 intent-to-treat patients, 379 (58%) were valid to assess efficacy (183 moxifloxacin, 196 comparator). Demographic and baseline medical characteristics were similar between the 2 groups. Clinical cure rates at test-of-cure were 80% (146 of 183) for moxifloxacin versus 78% (153 of 196) for comparator (95% confidence interval, -7.4%, 9.3%). The clinical cure rate at test-of-cure for hospital-acquired cIAI was higher with moxifloxacin (82%, 22 of 27) versus comparator (55%, 17 of 31; P = 0.05); rates were similar for community-acquired infections (80% [124 of 156] versus 82% [136 of 165], respectively). Bacterial eradication rates were 78% (117 of 150) with moxifloxacin versus 77% (126 of 163) in the comparator group (95% confidence interval, -9.9%, 8.7%). CONCLUSIONS Once daily IV/PO moxifloxacin monotherapy was as least as effective as standard IV piperacillin-tazobactam/PO amoxicillin-clavulanate dosed multiple times daily for the treatment of cIAIs.
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Affiliation(s)
- Mark A Malangoni
- Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH 44109-1998, USA.
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Malangoni MA. Contributions to the management of intraabdominal infections. Am J Surg 2005; 190:255-9. [PMID: 16023441 DOI: 10.1016/j.amjsurg.2005.05.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 04/15/2005] [Indexed: 11/24/2022]
Abstract
Intraabdominal infection represents a spectrum of diseases with a common pathogenesis. Establishing a prompt diagnosis and avoiding treatment delays are keys to achieving the best outcomes. Mortality depends on initiating early appropriate treatment to restore fluid and electrolyte imbalances, supporting the function of vital organs, providing appropriate broad-spectrum antimicrobial therapy, and achieving adequate source control. Faculty from the Department of Surgery at the University of Louisville have made significant contributions to the understanding and management of intraabdominal infections that have affected clinical practice and patient outcomes.
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Affiliation(s)
- Mark A Malangoni
- Department of Surgery, MetroHealth Medical Center, 2500 MetroHealth Dr., Cleveland, OH 44109, USA.
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21
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Alberts MJ, Latchaw RE, Selman WR, Shephard T, Hadley MN, Brass LM, Koroshetz W, Marler JR, Booss J, Zorowitz RD, Croft JB, Magnis E, Mulligan D, Jagoda A, O'Connor R, Cawley CM, Connors JJ, Rose-DeRenzy JA, Emr M, Warren M, Walker MD. Recommendations for Comprehensive Stroke Centers. Stroke 2005; 36:1597-616. [PMID: 15961715 DOI: 10.1161/01.str.0000170622.07210.b4] [Citation(s) in RCA: 400] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
To develop recommendations for the establishment of comprehensive stroke centers capable of delivering the full spectrum of care to seriously ill patients with stroke and cerebrovascular disease. Recommendations were developed by members of the Brain Attack Coalition (BAC), which is a multidisciplinary group of members from major professional organizations involved with the care of patients with stroke and cerebrovascular disease.
Summary of Review—
A comprehensive literature search was conducted from 1966 through December 2004 using Medline and Pub Med. Articles with information about clinical trials, meta-analyses, care guidelines, scientific guidelines, and other relevant clinical and research reports were examined and graded using established evidence-based medicine approaches for therapeutic and diagnostic modalities. Evidence was also obtained from a questionnaire survey sent to leaders in cerebrovascular disease. Members of BAC reviewed literature related to their field and graded the scientific evidence on the various diagnostic and treatment modalities for stroke. Input was obtained from the organizations represented by BAC. BAC met on several occasions to review each specific recommendation and reach a consensus about its importance in light of other medical, logistical, and financial factors.
Conclusions—
There are a number of key areas supported by evidence-based medicine that are important for a comprehensive stroke center and its ability to deliver the wide variety of specialized care needed by patients with serious cerebrovascular disease. These areas include: (1) health care personnel with specific expertise in a number of disciplines, including neurosurgery and vascular neurology; (2) advanced neuroimaging capabilities such as MRI and various types of cerebral angiography; (3) surgical and endovascular techniques, including clipping and coiling of intracranial aneurysms, carotid endarterectomy, and intra-arterial thrombolytic therapy; and (4) other specific infrastructure and programmatic elements such as an intensive care unit and a stroke registry. Integration of these elements into a coordinated hospital-based program or system is likely to improve outcomes of patients with strokes and complex cerebrovascular disease who require the services of a comprehensive stroke center.
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Affiliation(s)
- Mark J Alberts
- Northwestern University Medical School, 710 N Lake Shore Dr, Room 1420, Chicago, IL 60611, USA.
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Barie PS, Hydo LJ, Eachempati SR. Longitudinal outcomes of intra-abdominal infection complicated by critical illness. Surg Infect (Larchmt) 2005; 5:365-73. [PMID: 15744128 DOI: 10.1089/sur.2004.5.365] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Critically ill surgical patients remain at high risk of adverse outcomes as a result of intra-abdominal infections, including prolonged length of stay, organ dysfunction, and death despite advances in critical care and innovations in management of the peritoneal cavity. We evaluated the causes and consequences of intra-abdominal infections among critically ill surgical patients in a single tertiary-care intensive care unit (ICU) over a decade. METHODS Prospective study of 465 critically ill surgical patients with hollow viscus perforation and peritonitis or abscess from 1991-2002. Data collected were age, gender, admission APACHE III score, multiple organ dysfunction score, ICU and hospital length of stay, abscess (yes/no), site and type of perforation (colon vs. other), de novo vs. nosocomial origin, and mortality. Statistical analysis was by univariate ANOVA for coordinate data, Fisher exact test for continuous data, and logistic regression analysis. RESULTS The incidence of intra-abdominal infection was 5.75%, 73.7% of the patients developed organ dysfunction, and mortality was 22.6%. Females comprised 46.8% of the patients. De novo infection represented 71.8% of cases, whereas nosocomial infection comprised 28.2% of cases. Perforations were of the colon (including the appendix) 49.9% of the time. An abscess formed in 22.3% of patients; the remainder had peritonitis but no abscess. Patients in the cohort with peritonitis were older (p = 0.0157), sicker on admission (p = 0.0411) and developed more organ dysfunction (p = 0.0072), but had the same rate of mortality. Despite steadily increasing acuity since 1991 (r(2) = .71, p < 0.0001), the magnitude of organ dysfunction (r(2) = 0.11) and the mortality rate remained constant (r(2) = .01). By logistic regression, abscess correlated with less severe organ dysfunction (score > or = 5 [odds ratio 0.54, 95% CI 0.33-0.90] and > or =9 points [odds ratio 0.38, 95% CI 0.20-0.74]), and increasing magnitude of organ dysfunction was associated with mortality (each point [odds ratio 1.46, 95% CI 1.32-1.61]). CONCLUSIONS Although outcomes are improving, generalized peritonitis still causes high organ dysfunction-related mortality among critically ill surgical patients. Further improvements in resuscitation, surgical technique, and pharmacotherapy of severe intra-abdominal infections are needed.
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Affiliation(s)
- Philip S Barie
- Department of Surgery, Division of Critical Care and Trauma, Weill Medical College of Cornell University, New York, NY 10021, USA.
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Strickland AK, Martindale RG. The increased incidence of intraabdominal infections in laparoscopic procedures: potential causes, postoperative management, and prospective innovations. Surg Endosc 2005; 19:874-81. [PMID: 15933899 DOI: 10.1007/s00464-004-8211-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Accepted: 02/09/2005] [Indexed: 10/25/2022]
Abstract
We conducted a review of the literature to identify some potential causes for the increased incidence of intraabdominal infections seen after laparoscopic procedures. We also discuss the postoperative management of this condition and provide a prospective overview of innovations that may be helpful in such cases in the future.
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Affiliation(s)
- A K Strickland
- Department of Surgery, Medical College of Georgia, 1120 15th St, Augusta, GA 30912-4004, USA.
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Madbouly KM, Remzi FH, Erkek BA, Senagore AJ, Baeslach CM, Khandwala F, Fazio VW, Lavery IC. Recurrence after transanal excision of T1 rectal cancer: should we be concerned? Dis Colon Rectum 2005; 48:711-9; discussion 719-21. [PMID: 15768186 DOI: 10.1007/s10350-004-0666-0] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Transanal excision is an appealing treatment for low rectal cancers because of its low morbidity, mortality, and better functional results than transabdominal procedures. However, controversy exists about whether it compromises the potential for cure. Several, recent reports of high recurrence rates after local excision prompted us to review our results of transanal excision alone in patients with T1 rectal cancers. METHODS All patients with T1 low rectal cancer undergoing local excision alone between 1980 through 1998 were reviewed for local recurrence, distant metastasis, disease-free interval, results of salvage surgery, and overall and disease-free survival. Demographics, tumor size, distance from anal verge, and preoperative endoluminal ultrasound results also were recorded. Patients with poorly differentiated tumors, perineural or lymphovascular invasion, or with mucinous component were excluded. RESULTS Fifty-two patients underwent transanal excision during the study period. Five-year recurrence was estimated to be 29.38 percent (95 percent confidence interval, 15.39-43.48). For 52 patients, five-year, cancer-specific and overall survival rates were 89 and 75 percent respectively. Fourteen of 15 patients with recurrence underwent salvage treatment with 56.2 percent (95 percent confidence interval, 35.2-90) five-year survival rate. Gender, preoperative staging by endorectal ultrasound, distance from the anal verge, tumor size, location, and T1 status discovered after transanal excision of a villous adenoma did not influence local recurrence or tumor-specific survival. CONCLUSIONS Transanal excision for T1 rectal tumors with low-grade malignancy has a high rate of recurrence. Although overall cancer survival rates might be regarded as satisfactory, this high recurrence and low salvage rate raises the issue about the role of transanal excision alone for early rectal cancer and the possible need for adjuvant therapy or increased role of resective surgery.
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Affiliation(s)
- Khaled M Madbouly
- Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Taylor E, Berjis A, Bosch T, Hoehne F, Ozaeta M. The Efficacy of Postoperative Oral Antibiotics in Appendicitis: A Randomized Prospective Double-Blinded Study. Am Surg 2004. [DOI: 10.1177/000313480407001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The conventional treatment of acute appendicitis is appendectomy followed by intravenous (IV) antibiotics until intraabdominal infection has resolved. It is controversial as to whether it is efficacious to add a course of oral antibiotics after cessation of IV antibiotics. All consenting patients who presented to Kern Medical Center between October 2000 and June 2003 with acute appendicitis were entered into the study. Perforated/gangrenous appendicitis was equally represented in the two study arms. After appendectomy, and when IV antibiotics were ready to be discontinued, patients were randomized to receive a 7-day outpatient course of either placebo (Group 1) or oral antibiotics (Group 2). Patients were monitored for infectious complications for a minimum of 3 months, and there was no statistical difference (11.5% in Group 1 vs 12.1% in Group 2, P = 0.61). The data suggest that adding a course of outpatient oral antibiotics, after completing a course of IV antibiotics, does not decrease postoperative infectious complications in appendicitis patients.
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Affiliation(s)
- Edward Taylor
- From the Department of Surgery, Kern Medical Center, Bakersfield, California
| | - Amir Berjis
- From the Department of Surgery, Kern Medical Center, Bakersfield, California
| | - Theodore Bosch
- From the Department of Surgery, Kern Medical Center, Bakersfield, California
| | - Francesca Hoehne
- From the Department of Surgery, Kern Medical Center, Bakersfield, California
| | - Maria Ozaeta
- From the Department of Surgery, Kern Medical Center, Bakersfield, California
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Abstract
BACKGROUND The incidence and risk factors for severe sepsis (SS, organ failure associated with infection) in the context of peritonitis are not well established; thus, it is not clear which patients require more aggressive operative or pharmacologic intervention. We set out to determine risk factors for severe sepsis in a large cohort of patients with intra-abdominal infection. METHODS Patients admitted for peritonitis over a four-year interval were identified using a Washington State administrative hospital discharge database. This cohort was identified by ICD-9 CM diagnoses and diagnosis-related group (DRG) assignment. Patients with organ failure were identified by ICD-9 CM diagnoses codes using a previously validated classification scheme. Independent risk factors for SS were identified using stepwise Poisson regression. RESULTS A total of 11,202 patients with peritonitis were identified, 11% of whom developed SS. The crude relative risk of death in patients with SS was 13 (95% CI, 11.1-15.2) times greater than those without. Severe sepsis was present in 424 (62%) of the 686 decedents. Multivariate analysis showed that source of infection, extent of peritonitis, increasing age, and pre-existing organ dysfunction were independently associated with SS. CONCLUSIONS Severe sepsis complicates the course of 11% of all patients with peritonitis. Risk factor analysis identifies a subset of patients at greatest risk for severe sepsis. These are the patients who should be targeted for evaluation of novel pharmacologic interventions or more aggressive surgical intervention.
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Affiliation(s)
- Daniel A Anaya
- Division of General and Trauma Surgery, Harborview Medical Center, and the Department of Surgery, University of Washington, Seattle, Washington 98104-2499, USA
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Merlino JI, Yowler CJ, Malangoni MA. Nosocomial Infections Adversely Affect the Outcomes of Patients with Serious Intraabdominal Infections. Surg Infect (Larchmt) 2004; 5:21-7. [PMID: 15142420 DOI: 10.1089/109629604773860273] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with serious intraabdominal infections (IAI) who subsequently acquire nosocomial infections (NI) have been shown to have adverse outcomes. We evaluated factors that put patients at risk for developing NI and examined the effect of the NI on outcomes. METHODS This study was a retrospective review of NI among 168 patients diagnosed with IAI over a seven-year period. RESULTS Sixty-six patients (39.3%) developed 98 NI (23 urinary tract, 20 surgical site, 19 pneumonia, 14 bloodstream, 12 recurrent peritonitis, seven intravascular catheter-related, and three enteric). There were 35 males and 31 females. Patients with NI were older (56.0 +/- 18.3 vs. 47.0 +/- 15.6 years, p = 0.001), had a higher admission APACHE II score (10.7 +/- 6.1 vs. 7.5 +/- 5.1 points, p = 0.001), and more often had concomitant medical diagnoses (27.3% vs. 12.7%, OR = 2.57, 95% CI: 1.159-5.69, p = 0.018) than those who did not develop infection. Antimicrobial resistance among the IAI was higher in the NI group (19.7 vs. 5.9%, OR = 3.93, 95% CI: 1.41-10.93, p = 0.006). Patients who developed NI had an increased mortality rate (27.0% vs. 4.0%, OR = 8.87, 95% CI: 2.82-27.86, p < or = 0.0001), longer hospital stay (24.7 +/- 19.5 vs. 11.7 +/- 8.1 days, p < or = 0.0001), required more days of intravenous antibiotics (11.5 +/- 8.0 vs. 7.6 +/- 4.4 days, p < or = 0.0001), and were more likely to be admitted to an intensive care unit (54.5% vs. 25.5%, OR = 3.51, 95% CI: 1.82-6.77, p < or = 0.0001). Multivariate analysis demonstrated that antimicrobial resistance and an APACHE II score of > or = 10 independently predicted the development of a nosocomial infection. Age >/= 50 years, APACHE II score > or = 10, or the presence of a NI independently predicted death. CONCLUSIONS The development of NI following treatment of an IAI significantly affects mortality, hospital length of stay, and treatment. Early recognition and treatment of these infections, combined with strategies to prevent NI, may be important to improve outcomes in this patient population.
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Affiliation(s)
- James I Merlino
- Department of Surgery, MetroHealth Medical Center Campus, Case Western Reserve University, Cleveland, Ohio 44109, USA
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Abstract
Intra-abdominal infection is common and frequently seen by the surgeon. Mortality is related to disease acuity and organ failure. This report, based on medical literature and personal experience, is a brief review of this subject, highlighting important historical milestones and recent advances in surgical and antibiotic therapy. Peritonitis remains a clinical challenge. Aggressive resuscitation, diagnostic imaging, and surgical treatment are the mainstays of appropriate therapy. Percutaneous drainage of intra-abdominal collections has increased over time and is particularly helpful in certain postoperative patients. Adjunctive antibiotic therapy against gram-negative aerobes and anaerobes should be limited to a 7- to 10-day course, except in selected patients, such as those with inadequate source controls.
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Affiliation(s)
- William G Cheadle
- Veterans Affairs Medical Center and the Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky 40292, USA.
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29
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Abstract
Peritonitis is a serious and common infection. Its pathogenesis and microbiology have been well defined. Such risk factors as age, site of infection, physiologic response of the patient, presence of organ dysfunction, and malnutrition may influence the outcome of this disease process. The presence of antibiotic-resistant organisms and delays in operative intervention are also associated with treatment failure and higher mortality. Surgeons have the greatest impact on this disease in their ability to control the source of infection and to administer proper antimicrobial therapy.
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Affiliation(s)
- Mark A Malangoni
- Department of Surgery, MetroHealth Medical Center, 2500 MetroHealth Drive, H-914, Cleveland, OH 44109, USA.
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de Gara CJ, Hanson J, Hamilton S. A population-based study of tumor-node relationship, resection margins, and surgeon volume on gastric cancer survival. Am J Surg 2003; 186:23-7. [PMID: 12842743 DOI: 10.1016/s0002-9610(03)00116-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastric cancer surgery literature is conflicting. Two European level I randomized controlled trials refute Asian lesser level evidence promoting more radical resections. Population-based study evidence is undefined. METHODS Using this study design we examined the overall survival, the tumor-node relationship, margins, and surgeon volume on gastric cancer survival in a Canadian province. RESULTS Between 1991 and 1997, 577 (71 +/- 13 years 60% male) gastric adenocarcinomas were diagnosed in Northern Alberta (population 1.7 million). Respectively, median survival in months for stage I (n = 67) was 77, stage II (n = 55) 75, stage III (n = 155) 12, stage IV (n = 235) 3, and 65 unstaged (n = 65) 4. Five-year survival for T1N0 (n = 28) was 68% versus T1N1 (n = 7) 71% (P = 0.80); for T2N0 (n = 29) 58% versus T2N1 (n = 19) 58% versus T2N3 (n = 7) 29% (P = 0.08); for T3N0 (n = 33) 57%, versus T3N1 (n = 98) 9% versus T3N2 (n = 47) 0% versus T3N3 (n = 8) 0% (P < 0.0001). Median gastrectomy survival (months) in stage III was 15 months margin negative versus 8 months margin positive versus 6 bypass and 5 for no surgery (P = 0.0004). In stage IV it was margin positive 8 versus margin negative 6 (nonsignificant), bypass 3 versus no surgery 2. Five-year survival for surgeons doing fewer than 20 gastrectomies (n = 196 patients) was 29% (median 1.4 years) versus 35% (median 2.3 years; n = 72 patients) for surgeons doing 20 or more (n = 4; P = 0.325). CONCLUSIONS From these population data we conclude that (1) few patients present with "curable" gastric cancer, (2) node negative or small gastric cancer survival is not influenced by nodal stage, (3) positive margin resection survival is better than bypass or no surgery in stage IV but not stage III disease, and (4) surgeon volume does not appear to influence patient survival.
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Affiliation(s)
- Chris J de Gara
- Departments of Surgery and Epidemiology, Cross Cancer Institute, University of Alberta, 11560 University Avenue, Edmonton, Alberta T6G 1Z2, Canada.
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